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Mental health

Attention deficit hyperactivity disorder

Last revised in February 2025

Attention deficit hyperactivity disorder (ADHD) is a behavioural syndrome characterized by hyperactivity, impulsivity, and inattention.

Attention deficit hyperactivity disorder: Summary

  • Attention deficit hyperactivity disorder (ADHD) is a behavioural syndrome characterized by hyperactivity, impulsivity, and inattention.
  • ADHD should be suspected if the core symptoms of hyperactivity, inattention, and/or impulsivity have been present since childhood. These core symptoms are age-inappropriate and result in significant psychological, social, and/or educational functional impairment. When assessing a child with possible ADHD it is important to note that:
    • Symptoms typically appear in children 3–7 years of age, but may not be recognized until after 7 years of age, especially if hyperactivity is not present.
    • Symptoms should be present for at least 6 months.
    • Symptoms should be pervasive in at least two settings, such as home, school, social situations, or work.
    • Other causes for symptoms should be excluded, such as general or specific learning difficulties; anxiety; depression; abuse; trauma; or rarely, medical conditions, such as unsuspected hearing problems or epilepsy.
  • The diagnosis and treatment of ADHD requires referral and assessment by a specialist. However, some children, with symptoms that are causing only a moderate impairment to their ability to function socially and at school, can initially be managed in primary care with self-help, simple behavioural management or parent support programmes.
  • Referral may be to a specialist paediatrician, a child psychiatrist, Child and Adolescent Mental Health Services (CAMHS), or an adult psychiatrist, depending on the age of the person and local service provision.
  • The management of people with confirmed ADHD should be initiated and co-ordinated by specialists.
  • The treatment options offered by a specialist depend on the person's age and the degree of functional impairment and may include:
    • Parent education/support programmes.
    • Group psychological treatment (cognitive behavioural therapy [CBT] and/or social skills training).
    • Individual psychological treatment.
    • Drug treatment (methylphenidate, atomoxetine, dexamfetamine, or lisdexamfetamine).
  • People with a diagnosis of ADHD should eat a balanced diet and take regular exercise.
    • Eliminating artificial colourings and additives from the diet is not recommended unless there appears to be a link between certain foods or drinks and a person’s ADHD symptoms.

Have I got the right topic?

From age 36 months to 60 years.

This CKS topic is based on the National Institute for Health and Care Excellence guideline Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults [NICE, 2019].

This CKS topic covers the diagnosis, assessment, and management in primary care of suspected attention deficit hyperactivity disorder (ADHD) in children, young people, and adults.

This CKS topic does not cover in detail the diagnosis and management of ADHD by specialists, or the management of comorbidities associated with ADHD.

There are separate CKS topics on Learning disabilities, Bipolar disorder, Conduct disorders in children and young people, Depression, and Depression in children.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

February 2025 — minor update. Added information regarding gambling-related harms as a potential issue to consider in adults with ADHD in line with the NICE guideline Gambling-related harms: identification, assessment and management.  

Previous changes

December 2024 — minor update. Bruxism added as an adverse effect of unknown frequency for atomoxetine, in line with manufacturer's SPC.

October 2024 — minor update. Risk of serotonin syndrome has been added to adverse effects of Atomoxetine in line with manufacturer's SPC.

September 2024 — minor update. Minor text changes have been made in the section on Definitions.

August 2024 — minor update. Minor typographical error corrected. Added information regarding disinhibited social engagement disorder and reactive attachment disorder in the differential diagnosis section. 

April 2024 — minor update. Epistaxis added as an adverse effect of lisdexamfetamine, and contusion as an adverse effect of methylphenidate, as per the manufacturers' updated SPCs.

September 2023 — minor update. Added new product availability of melatonin for treatment of insomnia in children and adolescents aged 6-17 years with attention deficit hyperactivity disorder (ADHD), where sleep hygiene measures have been insufficient.

August 2023 — reviewed. A literature search was conducted in June 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. There have been no changes made to the recommendations.

November 2022 — minor update. Management in specialist settings updated to include the option of melatonin medication in use for children and young people with insomnia aged 6-17 with ADHD, where sleep hygiene measures have been insufficient.

October 2022 — minor update. Adverse effects of dexamfetamine sulfate updated in line with the manufacturer's updated SPC.

January 2021 — minor update. Adverse effects of methylphenidate updated in line with revised manufacturer's SPC.

November 2020 — minor update. QTc interval prolongation added as an adverse effect of amfetamines in line with revised manufacturer's SPC.

October 2020 — minor update. Dysphemia has been added as an adverse effect of methylphenidate in line with revised manufacturer's SPC.

May 2018 — reviewed. A literature search was conducted in February 2018 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

November 2017 — minor update to adverse effects of lisdexamfetamine to reflect changes in manufacturer's Summary of Product Characteristics.

December 2016 — Dysgeusia has been added as a possible adverse effect of lisdexamfetamine, and serotonin and noradrenaline reuptake inhibitors (SNRIs) have been included in the section on drug interactions, to reflect the updated Summary of Product Characteristics.

October 2015 — minor update. Update to the topic to reflect a new law on drugs and impaired driving.

May 2014 — minor update. Update to the adverse effects section of the topic to reflect new guidance from the manufacturer regarding driving regulation and methylphenidate.

August 2013 — reviewed. A literature search was conducted in August 2013 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. The structure of this topic has been changed to improve clarity; however there are no changes to the recommendations.

November 2012 — minor update. The links to the electronic medicines website (www.medicines.org.uk) have been updated.

February 2012 — minor update. Updated to include new safety information about the importance of regularly monitoring people on atomoxetine, published by the Medicines and Healthcare products Regulatory Agency (MHRA). 

February to June 2009 — this is a new CKS topic, based on the National Institute for Health and Care Excellence guideline Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults.

Update

New evidence

Evidence-based guidelines

HTAs (Health Technology Assessments)

No new HTAs since 1 July 2023.

Economic appraisals

No new economic appraisals relevant to England since 1 July 2023.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 July 2023.

Primary evidence

  • Price, A., Becker, K., Ward, J.H., et al. (2024) Support for primary care prescribing for adult ADHD in England: national survey. British Journal of General Practice. https://bjgp.org/ [Free Full-text]
  • O'Nions, E., El Baou, C., John, A., et al. (2025) Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. British Journal of Psychiatry https://www.cambridge.org/universitypress [Free Full-text]

New policies

No new national policies or guidelines since 1 July 2023.

New safety alerts

No new safety alerts since 1 July 2023.

Changes in product availability

  • New product Ceyesto (melatonin) 1mg/ml oral solution is now licensed to treat insomnia in children and adolescents aged 6-17 years with attention deficit hyperactivity disorder (ADHD), where sleep hygiene measures have been insufficient. See more here.
  • New product Atenza (methylphenidate) XL prolonged release tablets (18mg, 27mg, 36mg and 54 mg). Atenza XL is a once daily preparation licensed for use as part of a comprehensive treatment programme for Attention Deficit Hyperactivity Disorder in children aged 6 years of age and over and adults when remedial measures alone prove insufficient. See more here.
  • New product: Kixel XL (methylphenidate hydrochloride) 18 mg/1 tablet Prolonged-release tablet. This modified-release methylphenidate product is licensed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6 years of age and over and adults when remedial measures alone prove insufficient. See more here.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Suspect, assess and detect attention deficit hyperactivity disorder (ADHD) in young people and adults.
  • Ensure appropriate referral to specialist teams for confirmation of the diagnosis and initiation of treatment, where appropriate.
  • Monitor, liaise with, and support the person and their carers in primary care, where appropriate.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

  • Children and young people with symptoms of attention deficit hyperactivity disorder (ADHD) are referred to an ADHD specialist for assessment.
  • Adults who present with symptoms of attention deficit hyperactivity disorder (ADHD), who do not have a childhood diagnosis of ADHD, are referred to an ADHD specialist for assessment.
  • Adults who were diagnosed with and treated for attention deficit hyperactivity disorder (ADHD) as children or young people and present with symptoms of continuing ADHD are referred to general adult psychiatric services.
  • Parents or carers of children with symptoms of attention deficit hyperactivity disorder (ADHD) who meet the NICE eligibility criteria are offered a referral to a parent training programme.
  • People with attention deficit hyperactivity disorder (ADHD) who are starting drug treatment have their initial drug dose adjusted and response assessed by an ADHD specialist.
  • People with attention deficit hyperactivity disorder (ADHD) who are taking drug treatment have a specialist review at least annually to assess their need for continued treatment.

[NICE, 2018]

Background information

What is it?

  • Attention deficit hyperactivity disorder is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. The definition requires that symptoms:
    • Start before 12 years of age.
    • Occur in two or more settings, such as at home and school.
    • Have been present for at least 6 months.
    • Interfere with, or reduce the quality of social, academic or occupational functioning.
    • Do not occur exclusively during the course of a psychotic disorder and are not better explained by another mental disorder.
  • Inattention is manifested by wandering off task, difficulty with persistence, difficulty sustaining focus, and with organization.
  • Hyperactivity:
    • In a child is manifest by excessive motor activity when it is not appropriate (such as running around), or by excessive fidgeting, tapping, or talkativeness.
    • In an adult is manifest by extreme restlessness or wearing others out with their activity.
  • Impulsivity refers to hasty actions that occur in the moment without forethought and that have high potential for harm to the individual. Impulsive behaviour may manifest as social intrusiveness (for example, interrupting others excessively) and/or making important decisions without considering the long-term consequences (for example, taking on a job without adequate information).

[APA, 2022; BMJ Best Practice, 2022; BMJ Best Practice, 2023]

What causes it?

  • The cause of attention deficit hyperactivity disorder (ADHD) is unknown but involves the interplay of multiple genetic and environmental factors that are thought to lead to altered brain neurochemistry and structure.
    • There is substantial evidence for a genetic contribution to ADHD, with a mean heritability of 76% demonstrated in twin studies. It has been hypothesised that several genes may interact to cause ADHD, or that ADHD may be the common phenotype for numerous variant alleles.
    • Environmental factors most strongly associated with ADHD are low birth weight and maternal smoking during pregnancy. Other risk factors include preterm delivery, epilepsy, acquired brain injury, lead exposure, iron deficiency, alcohol exposure during pregnancy, psychosocial adversity, and adverse maternal mental health.
    • Overall, ADHD can be viewed as a heterogeneous disorder with different subtypes resulting from differing combinations of risk factors.

[Johnson, 2020; BMJ Best Practice, 2022; BMJ Best Practice, 2023]

How common is it?

  • There are three subtypes of ADHD:
    • The inattentive subtype accounts for 20% to 30% of cases.
    • The hyperactive-impulsive subtype accounts for around 15% of cases.
    • The combined subtype accounts for 50% to 75% of cases.
  • The global prevalence of attention deficit hyperactivity disorder (ADHD) in children is estimated to be around 5%, while studies based on US populations (where rates of diagnosis and treatment tend to be highest) estimate the rate at between 8% and 10%. 
  • ADHD is more commonly diagnosed in boys than girls. Prevalence ratios are generally estimated at 2–5:1, while clinic populations show a ratio as high as 10:1. This sex difference may be due to the fact that boys present more often with disruptive behaviour that prompts referral, whereas girls more commonly have the inattentive subtype and have lower comorbidity with oppositional defiant disorder (ODD) and conduct disorder.
  • In the UK, the prevalence of ADHD in adults is estimated at 3% to 4%, with a male-to-female ratio of approximately 3:1.
  • ADHD is associated with poverty, lower family income and social class. In adults, it is more frequent in the unemployed and in people with disabilities.

[Posner, 2020; BMJ Best Practice, 2022; BMJ Best Practice, 2023]

What is the prognosis?

  • For children with attention deficit hyperactivity disorder (ADHD), a meta-analysis of follow-up studies found that at 25 years of age:
    • Approximately 15% retained the full ADHD diagnosis.
    • Approximately 65% were in 'partial remission' (with persistence of some symptoms and continuing functional impairment, such as psychological, social, or educational difficulties).
  • Over time, inattentive symptoms tend to persist and hyperactive-impulsive symptoms tend to recede.
  • ADHD is associated with psychiatric or neurodevelopmental comorbidity, including oppositional defiant disorder (ODD), conduct disorder, substance use disorder, and possibly mood disorders, such as depression and mania. Autism spectrum disorder, dyslexia, dyscalculia, and dyspraxia are also over-represented. The person's overall prognosis may therefore depend on the severity and management of any co-morbid disorders.

[Johnson, 2020; Asherson, 2022; BMJ Best Practice, 2022; BMJ Best Practice, 2023]

Diagnosis of attention deficit hyperactivity disorder

When should I suspect ADHD?

  • Suspect attention deficit hyperactivity disorder (ADHD) if there are at least six (five in adults) inattention symptoms and/or at least six (five in adults) hyperactivity-impulsivity symptoms that have:
    • Started before 12 years of age.
    • Occurred in two or more settings such as at home and school.
    • Been present for at least 6 months.
    • Clearly interfered with, or reduced the quality of social, academic or occupational functioning.
    • Not occurred exclusively during the course of a psychotic disorder and are not better explained by another disorder such as oppositional defiant disorder or conduct disorder.
  • Inattention symptoms include:
    • Failing to give close attention to detail or making careless mistakes in schoolwork, work, or other activities.
    • Difficulty in maintaining concentration when performing tasks or play activities.
    • Appearing not to listen to what is being said, as if the mind is elsewhere, without any obvious distraction.
    • Failing to follow through on instructions or finish a task (not because of oppositional behaviour or failure to understand).
    • Difficulty in organizing tasks and activities.
    • Reluctance, dislike, or avoidance of tasks that require sustained mental effort.
    • Losing items necessary for tasks or activities such as pencils, mobile phones, or wallets.
    • Easy distraction by extraneous stimuli.
    • Forgetfulness with regard to daily activities. 
  • Hyperactivity-impulsivity symptoms include:
    • Fidgeting with or tapping hands or feet, or squirming when seated.
    • Leaving the seat where remaining seated is expected, such as in a classroom.
    • Running about or climbing in situations where inappropriate. In adolescents or adults, this may be limited to a feeling of restlessness.
    • An inability to play or engage in leisure activities quietly.
    • Being 'on the go' or acting as if 'driven by a motor'. Others may experience the person to be restless or difficult to keep up with.
    • Talking excessively.
    • Blurting out an answer before a question has been completed.
    • Difficulty waiting his or her turn.
    • Interrupting or intruding on others.

Basis for recommendation

This information is based on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline Attention deficit hyperactivity disorder: diagnosis and management [NICE, 2019] , the diagnostic criteria for ADHD detailed in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) [APA, 2022], expert opinion in review articles Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know  [Johnson, 2020], Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations [Asherson, 2022] and the British Medical Journal (BMJ) Best Practice guides Attention deficit hyperactivity disorder in children [BMJ Best Practice, 2022] and Attention deficit hyperactivity disorder in children [BMJ Best Practice, 2023].

What else might it be?

  • Anxiety disorders — inattention in anxiety disorders is due to worry and rumination. For more information, see the CKS topic on Generalized anxiety disorder.
  • Depressive disorders — individuals with depression may present with poor concentration, which is usually associated with other symptoms of depression. For more information, see the CKS topic on Depression.
  • Autism spectrum disorder — the social disengagement, isolation, and indifference to facial and tonal communication seen in some individuals with autism spectrum disorder should be distinguished from the social dysfunction and peer rejection seen in some individuals with ADHD. Children with autism spectrum disorder (ASD) may have tantrums because of an inability to tolerate change from their expected routine, whilst children with ADHD may have tantrums due to impulsivity or poor self-control. ADHD can be comorbid with ASD. For more information, see the CKS topic on Autism in children.
  • Personality disorder — it is difficult to differentiate between ADHD and personality disorders. However, ADHD is not characterized by fear of abandonment, self-injury, extreme ambivalence, or other features of personality disorders.
  • Oppositional defiant disorder — people with ADHD might exhibit aversion towards school or mentally demanding tasks. In oppositional defiant disorder, aversion behaviour is characterized by negativity, hostility, and defiance, often specifically towards authority figures.
  • Conduct disorder — although the hyperactive and impulsive behaviour of children with ADHD can be disruptive, it does not violate societal norms or the rights of others as in conduct disorder. For more information, see the CKS topic on Conduct disorders in children and young people.
  • Other neurodevelopmental disorders — stereotypic movement disorder can be distinguished from increased motor activity that occurs in ADHD, in that the movements are generally fixed and repetitive (for example, body rocking and self-biting). Frequent multiple tics in Tourette's disorder can be easily mistaken for the fidgetiness that can occur with ADHD. Therefore, a prolonged observation may be needed to differentiate between multiple bouts of tics and fidgetiness. 
  • Specific learning disorder — characterized by inattention in children relating to a specific task (such as reading) with adequate performance in other academic areas.
  • Substance use disorders — can be difficult to differentiate from ADHD if the first presentation of ADHD symptoms follows the onset of abuse or frequent use. Clear evidence of onset of ADHD symptoms from parent/carer reports or previous records may be needed to differentiate from a substance use disorder. The two may be comorbid.
  • Neuro-cognitive disorder — major neuro-cognitive disorders, such as dementia, can usually be differentiated from ADHD by their later onset. For more information, see the CKS topic on Dementia.
  • Disruptive mood dysregulation disorder — characterized by pervasive irritability and intolerance of frustration, but impulsiveness and disorganization are not prominent features.
  • Bipolar disorder — characterized by increased impulsivity or inattention, accompanied by elevated mood, grandiosity, and other specific features. For more information, see the CKS topic on Bipolar disorder.
  • Disinhibited social engagement disorder (DSED) and reactive attachment disorder (RAD)— these are two trauma and stressor related disoders. DSED is characterized by indiscriminate behaviours and RAD by failure to seek or accept comfort and emotional withdrawal. They are considered different disorders but may co-exist. DSED and RAD are serious disorders of social functioning thought to have a poor long-term prognosis if untreated. These diagnoses should only be made of there is a history of serious early childhood maltreatment. 
  • Fetal alcohol syndrome —  associated with a host of adverse neurodevelopmental features, some of which overlap with the symptoms of ADHD. There may be a history of in utero alcohol exposure, although some parents may be reluctant to disclose this. Some affected individuals have distinct facial features (smooth philtrum, thin upper lip, upturned nose, epicanthal folds). However, these can be subtle and may require assessment by a clinical geneticist for confirmation. Microcephaly and shorter stature are sometimes observed.
  • Auditory or visual impairment — in infants and toddlers, inattentiveness may be secondary to hearing and vision problems.
  • Seizure disorder — Absence seizures can lead to episodic impairment of attention and focus. Drugs used to treat epilepsy can impair alertness. For more information, see the CKS topic on Epilepsy.

Basis for recommendation

This information is based on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline Attention deficit hyperactivity disorder: diagnosis and management [NICE, 2019] , the diagnostic criteria for ADHD detailed in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) [APA, 2022], expert opinion in review articles Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know  [Johnson, 2020], Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations [Asherson, 2022] and the British Medical Journal (BMJ) Best Practice guides Attention deficit hyperactivity disorder in children [BMJ Best Practice, 2022] and Attention deficit hyperactivity disorder in children [BMJ Best Practice, 2023].

Management

Scenario: Management of attention deficit hyperactivity disorder (ADHD)

From age 36 months to 60 years.

How do I manage someone with suspected ADHD?

The formal diagnosis and treatment of ADHD should be carried out by a specialist. However, some children, with symptoms that are causing only a moderate impairment to their ability to function socially and at school, can initially be managed in primary care with self-help, simple behavioural management, or parent support programmes.

  • If ADHD is suspected in a child:
    • Assess the social and educational impact of their symptoms.
      • For school-age children, the extent of impairment should be judged in the context of self-care (for example, eating, or hygiene), travelling independently, making and keeping friends, achieving in school, forming positive relationships with other family members, developing a positive self-image, avoiding criminal activity, avoiding substance misuse, maintaining emotional states free of excessive anxiety and unhappiness, and understanding and avoiding common hazards.
      • For adolescents, difficulties may extend to cover occupational or educational underachievement, dangerous driving, and difficulties in carrying out daily activities (such as shopping and organizing household tasks), in making and keeping friends, and intimate relationships (for example, excessive disagreement).
      • Primary care practitioners with appropriate training/expertise may wish to augment this assessment using the Strengths and Difficulties questionnaire or the Conners' rating scale. Strengths and Difficulties Questionnaires for different age groups can be found as PDF files on www.sdqinfo.org and the Conners' rating scale is available to purchase from www.pearsonclinical.co.uk.
    • If symptoms are having an adverse effect on the child/young person's development or family life, options include:
      • A period of watchful waiting of up to 10 weeks and encouraging self-help and simple behavioural management.
      • Offering parents or carers a referral to group-based ADHD-focused support.
    • Refer children to a CAMHS professional, specialist paediatrician, or child psychiatrist if:
      • Symptoms are severe.
      • A period of watchful waiting is not acceptable.
      • Behavioural and/or attention problems persist with at least moderate impairment following a period of watchful waiting or a parent support programme.
  • If ADHD is suspected in an adult:
    • Assess the psychological, social, educational or occupational impact of their symptoms. For adults, difficulties may extend to cover occupational or educational underachievement, dangerous driving, gambling, and difficulties in carrying out daily activities (such as shopping and organizing household tasks), in making and keeping friends, in intimate relationships (for example, excessive disagreement), and with childcare. Where symptoms are associated with moderate or severe psychological, social and/or educational or occupational impairment:
      • Refer people without a prior diagnosis of childhood ADHD for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD.
      • Refer people who have previously been treated for ADHD as children or young people to general adult psychiatric services for assessment. 

Basis for recommendation

These recommendations are largely based on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline Attention deficit hyperactivity disorder: diagnosis and management [NICE, 2019], Center for Disease Control and Prevention (CDC) Treatment recommendations for ADHD [CDC, 2022], expert opinion in review articles Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know [Johnson, 2020], Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations [Asherson, 2022] and the British Medical Journal (BMJ) Best Practice guides Attention deficit hyperactivity disorder in children [BMJ Best Practice, 2022] and Attention deficit hyperactivity disorder in adults [BMJ Best Practice, 2023].

How should I manage confirmed ADHD?

  • The management of people with confirmed attention deficit hyperactivity disorder (ADHD) should be initiated and coordinated by specialists. For further information, see Secondary care management.
  • Depending on locally-agreed shared care arrangements, drug treatments initiated and titrated by a specialist may be continued and monitored in primary care. Effectiveness and adverse effects of drug treatments should be documented in the person's notes, in addition to:
    • Weight:
      • Every three months in children 10 years old and younger.
      • Three months and six months after treatment has started, and every six months thereafter in children and young people over 10 years old.
      • Every six months in adults (monitor body mass index).
    • Height — every 6 months in children and young people.
      • Note: Plot height and weight of children and young people on a growth chart and ensure review by the healthcare professional responsible for their treatment.
    • Blood pressure and heart rate — before and after each dose change, and routinely every six months. Compare results with the normal range for the person's age.
    • Consider a sleep diary if problems with sleep are present. See the CKS topic on Insomnia for more information. 
  • Seek specialist advice if drug treatment results in sustained resting tachycardia (>120 bpm), arrhythmia, or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on two occasions, or other significant adverse effects develop. Specialist advice should also be sought if a child or young person's height over time is significantly affected by medication (that is, they have not met the height expected for their age), as a planned break in treatment over school holidays may be required to allow 'catch-up' growth.
  • For adults prescribed an amfetamine (for example, dexamfetamine or lisdexamfetamine), give advice on driving. Advise that:
    • They should not drive if they feel drowsy, dizzy, unable to concentrate or make decisions, or if they have blurred or double vision.
    • It is now an offence to drive if they have more than a specified amount of amfetamines in their body, whether driving is impaired or not. It may be helpful for the person to keep evidence (such as the other half of their prescription) in the car to show that they are taking the amfetamine in accordance with medical advice.
  • Advise people with ADHD to eat a normal healthy diet and take regular exercise:
    • Do not routinely recommend eliminating artificial colourings and additives from the diet. However, if there appears to be a link between certain foods or drinks and ADHD symptoms:
      • Advise parents or carers to keep a diary of food and drink consumed and associated behaviour.
      • Refer the person to a dietitian if the diary supports a relationship between specific foods or drinks and behaviour. Joint management by a dietitian, specialist, the parent or carer and the child or young person, is recommended before specific dietary elimination is considered.
    • Do not routinely recommend dietary fatty acid supplements for people with ADHD.
    • If weight loss becomes a problem, consider seeking specialist dietary advice and/or advise the person to:
      • Take ADHD medication either with or after food, rather than before meals.
      • Take additional meals or snacks early in the morning or late in the evening, when the effects of the drug have worn off.
      • Consume high-calorie foods of good nutritional value.
  • Ask families or carers of people with ADHD how the ADHD affects themselves and other family members, and discuss any concerns they have. Encourage them to seek an assessment of their personal, social and mental health needs, and to join self-help and support groups if appropriate. 
  • If appropriate, reinforce advice to parents and carers of children and young people with ADHD about the importance of:
    • Positive parent– and carer–child contact.
    • Clear and appropriate rules about behaviour and consistent management.
    • Structure in the child or young person's day. 
  • Give people with ADHD and their families written information about self-help, local and national support groups, and voluntary organizations, as appropriate. These include:

Secondary care management of ADHD

  • The treatment options offered by a specialist depend on the person's age and the degree of functional impairment.
    • For preschool children with attention deficit hyperactivity disorder (ADHD):
      • An ADHD-focused group parent-training programme is normally recommended first-line.
      • If ADHD symptoms across settings are still causing a significant impairment after environmental modifications have been implemented and reviewed, advice will be sought from a specialist ADHD service with expertise in managing ADHD in young children (ideally a tertiary service). Drug treatment may be considered with input from this service.
    • For school-age children and young people with ADHD:
      • Group-based support should be offered to parents/carers and/or young people with ADHD. It should include education and information on the causes and impact of ADHD and advice on parenting strategies. With consent, liaison with school, college or university should occur.
      • Individual parent-training programmes for parents and carers of children and young people with ADHD should be offered when there are particular difficulties for families in attending group sessions (for example, because of disability, needs related to diversity such as language differences, learning disability, parental ill-health, problems with transport, where other factors suggest poor prospects for therapeutic engagement, or when a family's needs are too complex to be met by group-based parent-training programmes.
      • Medication may be offered if ADHD symptoms are still causing a persistent significant impairment after environmental modifications have been implemented and reviewed. Methylphenidate is usually offered first-line, with lisdexamfetamine, dexamfetamine, and atomoxetine as possible alternatives if methylphenidate is contraindicated, not tolerated, or ineffective. Melatonin may be prescribed for children and adolescents aged 6-17 years with ADHD who have insomnia, where sleep hygiene measures have been insufficient.
      • A course of cognitive behavioural therapy (CBT) may be offered to young people with ADHD who have benefited from medication but whose symptoms are still causing significant impairment, addressing areas such as social skills with peers, problem-solving, self-control, active listening skills, and dealing with and expressing feelings.
    • For adults with ADHD:
      • Medication will usually be offered if ADHD symptoms are still causing a significant impairment after environmental modifications have been implemented and reviewed. Lisdexamfetamine or methylphenidate are usually offered first-line, with dexamfetamine or atomoxetine as possible alternatives if lisdexamfetamine and/or methylphenidate are contraindicated, not tolerated, or ineffective.
      • Non-pharmacological treatment in combination with medication may be considered for adults with ADHD who have benefited from medication but whose symptoms are still causing significant impairment. This can include a structured supportive psychological intervention focused on ADHD, regular follow-up either in person or by phone, and/or elements of a full course of CBT. 

Basis for recommendation

These recommendations are largely based on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline Attention deficit hyperactivity disorder: diagnosis and management [NICE, 2019] and the American Academy of Paediatrics guideline Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention Deficit/Hyperactivity Disorder in Children and Adolescents [Wolraich, 2019].

Medication prescription
Advice on driving
  • The recommendations on driving and amfetamine use are based on advice issued by the Department of Transport in the document Drugs and driving: the law [HM Government, 2022].
Behavioural interventions
  • There is low quality evidence that cognitive behavioural therapy is beneficial in the short-term for reducing symptoms of ADHD in adults [Lopez, 2018].
  • There is only weak evidence for the use social skills training in children with ADHD, particularly adolescents [Storebø, 2019].

Prescribing information

Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC), or the British National Formulary (BNF).

Methylphenidate

  • Methylphenidate is always initiated in secondary care by a specialist. However, treatment may be continued and monitored by a general practitioner under a shared-care protocol.

What adverse effects are associated with methylphenidate?

  • The most common adverse effects of methylphenidate include:
    • Gastrointestinal effects such as abdominal pain, nausea, vomiting, diarrhoea, dyspepsia, dry mouth, and anorexia.
    • Cardiovascular effects such as tachycardia, palpitation, arrhythmias, and changes in blood pressure.
    • Central nervous system effects such as insomnia, nervousness, asthenia, depression, irritability, aggression, headache, drowsiness, dizziness, dysphemia, and movement disorders.
      • Methylphenidate can impair cognitive function and affect the person's ability to drive. People taking methylphenidate should be told that this medicine may affect their ability to drive and they should not drive if they are affected.
    • Dermatological effects such as pruritus and rash.
    • Other adverse effects, including reduced weight gain, cough, nasopharyngitis, tics (very rarely Tourette syndrome), fever, arthralgia, alopecia, and growth restriction.
  • Less common adverse effects include constipation, dyspnoea, dysphemia, abnormal dreams, confusion, suicidal ideation, urinary frequency, haematuria, muscle cramps, epistaxis, and contusion.
  • Rarely, angina, sweating, and visual disturbances have been reported.
  • Very rarely, the following have been reported hepatic dysfunction, myocardial infarction, cerebral arteritis, psychosis, seizures, neuroleptic malignant syndrome, tolerance and dependence, blood disorders including leucopenia and thrombocytopenia, angle-closure glaucoma, exfoliative dermatitis, and erythema multiforme, supraventricular tachycardia, bradycardia, and convulsions.

[EMC, 2022a; BNF, 2023]

What key drug interactions are associated with methylphenidate?

Key drug interactions with methylphenidate include:

  • Anticoagulants — methylphenidate possibly enhances the effect of anticoagulants (for example, warfarin). Dose adjustment of these drugs might be needed when starting methylphenidate.
  • Antihypertensives — methylphenidate may decrease the effectiveness of drugs used to treat hypertension.
  • Antipsychotics — because a predominant action of methylphenidate is to increase extracellular dopamine levels, methylphenidate may be associated with pharmacodynamic interactions when co-administered with direct and indirect dopamine agonists, or with dopamine antagonists including antipsychotics.
  • Carbamazepine — carbamazepine may decrease the levels of methylphenidate and, therefore, it is advised to monitor the response to methylphenidate.
  • Drugs that elevate blood pressure — caution is advised in people being treated with methylphenidate with other drugs that can also elevate blood pressure.
  • Phenytoin — methylphenidate may rarely increase phenytoin levels and the risk of toxicity.
  • Monoamine oxidase inhibitors (MAOIs) — concurrent use of two or more serotonergic drugs may increase the risk of serotonin syndrome and symptoms similar to neuroleptic malignant syndrome. Additionally, concurrent use of MAOIs and methylphenidate may precipitate a hypertensive crisis. Therefore, do not prescribe an MAOI to a person taking methylphenidate. Be aware that methylphenidate should not be used for at least 14 days after stopping treatment with an MAOI, and treatment with an MAOI should not be initiated within 14 days after stopping methylphenidate. 
  • Selective serotonin reuptake inhibitors (SSRIs) — methylphenidate may increase the risk of central nervous system adverse effects of SSRIs. If this becomes troublesome, consider stopping one of the two drugs.
  • Tricyclic antidepressants (TCAs) — methylphenidate may increase both the effect and adverse effects of TCAs. Monitor for adverse effects of TCAs if concurrent use is indicated and if present, adjust the dose of the TCA as needed.
  • Alcohol — concomitant use of alcohol with methylphenidate enhances the effects of methylphenidate. Advise that alcohol should be avoided whilst taking methylphenidate.

[EMC, 2022a; BNF, 2023; Preston, 2023]

Atomoxetine

  • Atomoxetine is always initiated in secondary care by a specialist. However, treatment may be continued and monitored by a general practitioner under a shared-care protocol.

What adverse effects are associated with atomoxetine?

  • The most common adverse effects of atomoxetine include:
    • Gastrointestinal effects such as anorexia, dry mouth, nausea, vomiting, abdominal pain, constipation, dyspepsia, and flatulence.
    • Cardiovascular effects such as palpitation, tachycardia, increased blood pressure, postural hypotension, and hot flushes.
    • Central nervous system effects such as sleep disturbance, dizziness, headache, fatigue, lethargy, drowsiness, irritability, tremor, and rigours.
    • Dermatological effects such as dermatitis, pruritus, and rash.
    • Other effects, including sweating, weight changes, urinary retention, enuresis, prostatitis, sexual dysfunction, menstrual disturbances, and conjunctivitis.
  • Less common, but important adverse effects include:
    • Suicidal ideation — patients and carers should be aware of the risk and should be vigilant for any change in behaviour, suicidal thoughts, agitation, aggression, emotional lability, or depression.
    • Hepatic disorders — patients and carers should be aware of the risk and should be advised on the symptoms (abdominal pain, unexplained nausea, malaise, dark urine, or jaundice), suggesting liver damage, and encouraged to seek prompt medical help if this occurs.
    • Very rarely, angle-closure glaucoma.
    • Serotonin syndrome — when used concomitantly with other serotonergic medicines.
    • Bruxism (teeth grinding) — unknown frequency.
    • Aggressive behaviour, hostility or emotional lability has been reported in paediatric patients.

[EMC, 2020; BNF, 2023; EMC, 2024a]

What key interactions are associated with atomoxetine?

  • Monoamine oxidase inhibitors (MAOIs) — do not prescribe an MAOI to a person taking atomoxetine. Be aware that atomoxetine should not be used for at least 14 days after stopping treatment with an MAOI, and treatment with an MAOI should not be initiated within 14 days after stopping atomoxetine. Concurrent use of two or more serotonergic drugs may increase the risk of serotonin syndrome and symptoms similar to neuroleptic malignant syndrome.
  • The following drugs increase the risk of ventricular arrhythmias, and concurrent use with atomoxetine should be avoided (atomoxetine is associated with QT interval prolongation):
    • Methadone (dosage above 100 mg).
    • Disopyramide.
    • Nasal decongestants.
    • Amiodarone and sotalol.
    • Moxifloxacin.
    • Venlafaxine, mirtazapine, tricyclic antidepressants, and selective serotonin reuptake inhibitors
    • Mefloquine.
    • Antipsychotics such as haloperidol and pimozide.
    • Diuretics — the risk of ventricular arrhythmia is increased with diuretics that cause hypokalaemia.
  • Terbinafine — theoretically inhibits the cytochrome P450 enzyme and, therefore, increases the effect of atomoxetine. It is advised to start at a low dose and slowly titrate the dose when concurrent treatment with atomoxetine is indicated.

[EMC, 2020; Preston, 2023; BNF, 2023]

Amfetamines

  • Dexamfetamine and lisdexamfetamine are always initiated in secondary care by a specialist. However, treatment may be continued and monitored by a general practitioner under a shared-care protocol.

What adverse effects are associated with dexamfetamine and lisdexamfetamine?

  • Adverse effects of amfetamines include:
    • Metabolic effects such as decreased appetite with moderately reduced weight and growth during prolonged use.
    • Psychiatric effects such as insomnia, anxiety, aggression, agitation, lability, mood swings, and depression. 
    • Central nervous system effects such as dizziness, dyskinesia, tremor, psychomotor hyperactivity, confusion, irritability, and headache.
    • Cardiovascular system effects such as hypertension, tachycardia, QTc interval prolongation, cardiomyopathy, and myocardial infarction.
    • Gastrointestinal effects such as diarrhoea, constipation, abdominal cramps, nausea, and vomiting.
    • Urogenital effects such as sexual dysfunction.
    • Ophthalmological effects such as mydriasis. Very rarely, angle-closure glaucoma may occur.
    • Plasma corticosteroid levels — amphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening. Amphetamines may interfere with urinary steroid determinations.
    • Vascular disorders — such as epistaxis. 

[EMC, 2022b; BNF, 2023; EMC, 2024b]

What key interactions are associated with amfetamines (dexamfetamine and lisdexamfetamine)?

Key drug interactions with amfetamines include:

  • Moclobemide — may potentially cause a fatal hypertensive crisis and concurrent use with an amfetamine should be avoided.
  • Monoamine oxidase inhibitors (MAOIs) — concurrent use of two or more serotonergic drugs may increase the risk of serotonin syndrome and symptoms similar to neuroleptic malignant syndrome, therefore, do not prescribe an MAOI to a person taking an amfetamine. Be aware that an amfetamine should not be used for at least 14 days after stopping treatment with an MAOI, and treatment with an MAOI should not be initiated within 14 days after stopping an amfetamine.
  • Rasagiline — increases the risk of hypertensive crisis and concurrent use with an amfetamine should be avoided.
  • Atomoxetine — concurrent use with amfetamines increases the risk of psychosis and movement disorders. If concurrent use is indicated, be aware of this risk and consider reducing or stopping the drug if any symptoms of psychosis or movement disorders occur.
  • Haloperidol — concurrent use with amfetamines may inhibit the stimulant effect of the amfetamine and, therefore,  dexamfetamine and lisdexamfetamine may be less effective in people taking haloperidol.
  • Tricyclic antidepressants — concurrent use with amfetamines increases cardiovascular risk and should be avoided.
  • Selective serotonin reuptake inhibitors (SSRIs) or noradrenaline reuptake inhibitors (SNRIs) — concurrent use with amfetamines increases the risk of serotonin syndrome and neurotoxic reaction. The significance of this interaction is unclear but awareness of this interaction is advised.
  • HIV-protease inhibitors — concurrent use with amfetamines increases the concentration of amfetamines and is potentially fatal. Avoidance or dose reduction is advised.

[EMC, 2022b; Preston, 2023; BNF, 2023]

Supporting evidence

This CKS topic is largely based on the National Institute of Health and Care Excellence guideline Attention deficit hyperactivity disorder: diagnosis and management [NICE, 2019] , the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) [APA, 2022], the American Academy of Paediatrics Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention Deficit/Hyperactivity Disorder in Children and Adolescents [Wolraich, 2019], expert opinion in review articles Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know [Johnson, 2020], Attention-deficit hyperactivity disorder [Posner, 2020], Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations [Asherson, 2022], and the British Medical Journal (BMJ) Best Practice guides Attention deficit hyperactivity disorder in children [BMJ Best Practice, 2022] and Attention deficit hyperactivity disorder in adults [BMJ Best Practice, 2023].

The recommendations relevant to primary care were developed from the expert opinion of the guideline development group following narrative reviews of the evidence, where available. The evidence for specialist management strategies is not discussed as they are beyond the scope of this CKS topic.

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of attention deficit hyperactivity disorder.

Search dates

February 2018 - August 2023

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • exp Attention Deficit Disorder with Hyperactivity/, attention deficit disorder.tw., attention deficit-hyperactivity disorder.tw., attention deficit hyperactivity disorder.tw., attention-deficit hyperactivity disorder.tw., ADHD.tw.

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • APA (2022) Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision. Washington, DC. American Psychiatric Association. https://www.psychiatry.org [Free Full-text]
  • Asherson, P., Leaver, L., Adamou, M., et al. (2022) Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry 22(640). [Free Full-text]
  • BMJ Best Practice (2022) Attention deficit hyperactivity disorder in children. BMJ Publishing Group. https://bestpractice.bmj.com/topics/en-gb/142
  • BMJ Best Practice (2023) Attention deficit hyperactivity disorder in adults. BMJ Publishing Group. https://bestpractice.bmj.com/topics/en-gb/814
  • BNF (2023) British National Formulary. National Institute for Health and Care Excellence. https://bnf.nice.org.uk
  • Boesen K., Paludan-Müller AS., Gøtzsche PC. and Jørgensen KJ. (2022) Extended‐release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. (Cochrane Review/Cochrane Intervention Protocol). Issue 2. John Wiley & Sons, Ltd. https://www.cochranelibrary.com [Free Full-text]
  • Cândido R.C.F., Menezes de Padua C.A., Golder S. and Junqueira D.R. (2021) Immediate‐release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. (Cochrane Review/Cochrane Intervention Protocol). Issue 1. Art. No.: CD013011. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Castells X., Blanco‐Silvente L. and Cunill R. (2018) Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. (Cochrane Review/Cochrane Intervention Protocol). Issue 8. Art. No.: CD007813. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • CDC (2022) ADHD Treatment Recommendations. ADHD Website. Centers for Disease Control and Prevention. [Free Full-text]
  • Coghill, D., Banaschewski, T., Cortese, S., et al. (2021) The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). European Child & Adolescent Psychiatry 32, 1337-1361. [Abstract] [Free Full-text]
  • Cortese S., Adamo N., Del Giovane C., et al. (2018) Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 5(9), 727-738. [Free Full-text]
  • Eaton C., Yong K., Walter V., et al. (2022) Stimulant and non‐stimulant drug therapy for people with attention deficit hyperactivity disorder and epilepsy. Issue 7. Art. No.: CD013136. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • EMC (2020) SPC for Atomoxetine 80mg hard capsules. Electronic Medicines Compendium. Datapharm Communications Ltd. https://www.medicines.org.uk/emc [Free Full-text]
  • EMC (2022a) SPC for Methylphenidate Hydrochloride 5, 10 and 20 mg Tablets. Electronic Medicines Compendium. Datapharm Communications Ltd. [Free Full-text]
  • EMC (2022b) SPC for dexamfetamine 5mg tablets. Electronic Medicines Compendium. Datapharm Communications Ltd. [Free Full-text]
  • EMC (2024a) SPC for Atomoxetine 18 mg Capsules, Hard. Electronic Medicines Compendium. Datapharm Communications Ltd. https://www.medicines.org.uk [Free Full-text]
  • EMC (2024b) SPC for elvanse Adult 50mg Hard Capsules. Electronic Medicines Compendium. Datapharm Communications Ltd. https://www.medicines.org.uk/emc [Free Full-text]
  • Harstad E., Shults J., Barbaresi W., et al. (2021) Α2-Adrenergic Agonists or Stimulants for Preschool-Age Children With Attention-Deficit/Hyperactivity Disorder. Journal of the American Medical Association 325(20), 2067-2075. [Free Full-text]
  • HM Government (2022) Drugs and driving: the law. HM Government. https://www.gov.uk [Free Full-text]
  • Johnson J., Morris S. and George S. (2020) Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know. British Journal of Hospital Medicine 81(3), 1-11. [Abstract] [Free Full-text]
  • Lopez P.L., Torrente F.M., Ciapponi A., et al. (2018) Cognitive‐behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Issue 3. Art. No.: CD010840. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • NICE (2018) Attention deficit hyperactivity disorder (Quality Standard). National Institute for Health and Care Excellence. http://www.nice.org.uk [Free Full-text]
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  • Osland S.T., Steeves T.D.L. and Pringsheim T. (2018) Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders. Issue 6. Art. No.: CD007990. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Posner J., Polanczyk G.V. and Sonuga-Barke E. (2020) Attention-deficit hyperactivity disorder. Lancet 395(10222), 450-462. [Free Full-text]
  • Preston, C.L. (2023) Stockley's Drug Interactions. Medicines Complete. Pharmaceutical Press. https://www.new.medicinescomplete.com
  • Storebø O.J., Elmose Andersen M., Skoog M., et al. (2019) Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Issue 6. Art. No.: CD008223. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Storebø O.J., Storm M.R., Pereira Ribeiro J., et al. (2023) Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Issue 3. Art. No.: CD009885. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Wolraich, M.L., Hagan Jr, J.F., Allan, C., et al. (2019) Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 144(4). [Free Full-text]
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